Healthcare Provider Details

I. General information

NPI: 1649705062
Provider Name (Legal Business Name): KATIE WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 08/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LINCOLN PARK RD
SPRINGFIELD KY
40069-1501
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-858-6644
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number286643
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: